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Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia.

Schuetz P, Stolz D, Mueller B, Morgenthaler NG, Struck J, Mueller C, Bingisser R, Tamm M, Christ-Crain M - BMC Infect. Dis. (2008)

Bottom Line: The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]).ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]).ISRCTN04176397.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland. SchuetzP@uhbs.ch

ABSTRACT

Background: Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.

Methods: We evaluated 281 consecutive patients with community acquired pneumonia. Serum proET-1 plasma levels were measured using a new sandwich immunoassay.

Results: ProET-1 levels exhibited a gradual increase depending on the clinical severity of pneumonia as assessed by the pneumonia severity index (PSI) and the CURB65 scores (p < 0.001 and p < 0.01). The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]). ProET-1 levels on admission were increased in patients with adverse medical outcomes including death and need for ICU admission. ROC curve analysis to predict the risk for mortality showed a prognostic accuracy of proET-1 (AUC 0.64 [95%CI 0.53-0.74]), which was higher than C-reactive protein (AUC 0.51 [95%CI 0.41-0.61]) and leukocyte count (AUC 0.55 [95%CI 0.44-0.65]) and within the range of the clinical severity scores (PSI AUC 0.69 [95%CI 0.61-0.76] and CURB65 0.67 [95%CI 0.57-0.77]) and procalcitonin (AUC 0.59 [95% 0.51-0.67]). ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]). In a multivariate logistic regression model, only proET1 and the clinical severity scores were independent predictors for death and for the need for ICU admission.

Conclusion: In community-acquired pneumonia, ET-1 precursor peptides correlate with disease severity and are independent predictors for mortality and ICU admission. If confirmed in future studies, proET-1 levels may become another helpful tool for risk stratification and management of patients with community-acquired pneumonia.

Trial registration: ISRCTN04176397.

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ProET-1 levels in survivors and nonsurvivors.
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Figure 4: ProET-1 levels in survivors and nonsurvivors.

Mentions: At follow-up, an adverse medical outcome was noted in 61 patients (22%), including 35 deaths (13%) and 36 admissions to the ICU (13%). The reason for ICU relocations were need for invasive (n = 7) and non-invasive (n = 17) ventilation and hemodynamic stabilization because of sepsis related hypotension (n = 12). Ten patients who were admitted to the ICU subsequently died. In patients who died during follow-up, proET-1 (pmol/L) levels on admission were significantly higher as compared to levels in survivors (124.0 [IQR 91.7–199.0] vs. 92.9 [IQR 65.0–133.0], p = 0.008) (Figure 4). The respective values for other markers of infection were not significant (for procalcitonin: 0.61 [IQR 0.37–3.13] vs. 0.48 [IQR 0.18–2.45] μg/L (p = 0.09), for C-reactive protein 152 [IQR 84–211] vs. 132 [IQR 66–213] mg/L (p = 0.83) and for total leukocyte count (13.5 [IQR 10.3–16.9] vs. 12.7 [IQR 9.0–16.7] × 109/L (p = 0.35)). Moreover, proET1 levels but not procalcitonin, C-reactive protein and leukocyte count were elevated in patients with an adverse medical outcome consisting of either death or ICU admission (129.0 [IQR 94.6–191.0] vs. 88.2 [IQR 63.4–128.0] pmol/L, p < 0.0001) (Figure 5).


Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia.

Schuetz P, Stolz D, Mueller B, Morgenthaler NG, Struck J, Mueller C, Bingisser R, Tamm M, Christ-Crain M - BMC Infect. Dis. (2008)

ProET-1 levels in survivors and nonsurvivors.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2335111&req=5

Figure 4: ProET-1 levels in survivors and nonsurvivors.
Mentions: At follow-up, an adverse medical outcome was noted in 61 patients (22%), including 35 deaths (13%) and 36 admissions to the ICU (13%). The reason for ICU relocations were need for invasive (n = 7) and non-invasive (n = 17) ventilation and hemodynamic stabilization because of sepsis related hypotension (n = 12). Ten patients who were admitted to the ICU subsequently died. In patients who died during follow-up, proET-1 (pmol/L) levels on admission were significantly higher as compared to levels in survivors (124.0 [IQR 91.7–199.0] vs. 92.9 [IQR 65.0–133.0], p = 0.008) (Figure 4). The respective values for other markers of infection were not significant (for procalcitonin: 0.61 [IQR 0.37–3.13] vs. 0.48 [IQR 0.18–2.45] μg/L (p = 0.09), for C-reactive protein 152 [IQR 84–211] vs. 132 [IQR 66–213] mg/L (p = 0.83) and for total leukocyte count (13.5 [IQR 10.3–16.9] vs. 12.7 [IQR 9.0–16.7] × 109/L (p = 0.35)). Moreover, proET1 levels but not procalcitonin, C-reactive protein and leukocyte count were elevated in patients with an adverse medical outcome consisting of either death or ICU admission (129.0 [IQR 94.6–191.0] vs. 88.2 [IQR 63.4–128.0] pmol/L, p < 0.0001) (Figure 5).

Bottom Line: The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]).ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]).ISRCTN04176397.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland. SchuetzP@uhbs.ch

ABSTRACT

Background: Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.

Methods: We evaluated 281 consecutive patients with community acquired pneumonia. Serum proET-1 plasma levels were measured using a new sandwich immunoassay.

Results: ProET-1 levels exhibited a gradual increase depending on the clinical severity of pneumonia as assessed by the pneumonia severity index (PSI) and the CURB65 scores (p < 0.001 and p < 0.01). The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]). ProET-1 levels on admission were increased in patients with adverse medical outcomes including death and need for ICU admission. ROC curve analysis to predict the risk for mortality showed a prognostic accuracy of proET-1 (AUC 0.64 [95%CI 0.53-0.74]), which was higher than C-reactive protein (AUC 0.51 [95%CI 0.41-0.61]) and leukocyte count (AUC 0.55 [95%CI 0.44-0.65]) and within the range of the clinical severity scores (PSI AUC 0.69 [95%CI 0.61-0.76] and CURB65 0.67 [95%CI 0.57-0.77]) and procalcitonin (AUC 0.59 [95% 0.51-0.67]). ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]). In a multivariate logistic regression model, only proET1 and the clinical severity scores were independent predictors for death and for the need for ICU admission.

Conclusion: In community-acquired pneumonia, ET-1 precursor peptides correlate with disease severity and are independent predictors for mortality and ICU admission. If confirmed in future studies, proET-1 levels may become another helpful tool for risk stratification and management of patients with community-acquired pneumonia.

Trial registration: ISRCTN04176397.

Show MeSH
Related in: MedlinePlus